Mutual of Omaha presents Medicare Basics Health products underwritten by Mutual of Omaha Insurance Company For Producer Use Only. Not for use with the general public.
Why Mutual of Omaha? • A financially strong company with: -brand name recognition -quality products, excellent service and -committed to our community as demonstrated with our Wild Kingdom and sponsorship programs
WhyMutual of Omaha? • A financially strong company since 1909 • Rated A+ (Superior) by A.M. Best • Second of 16, for financial strength and ability to meet contractual obligations
Why Mutual of Omaha? • A provider of Medicare supplement insurance since 1966 • Mutual and United World paid $5.4 billion in Medicare supplement benefits* • Mutual and United World paid $780 million in Medicare supplement benefits in 2008 alone* • *Mutual of Omaha Actuarial Research, 2007
Why Mutual of Omaha? • Our Medicare supplement rates are top in the industry • We have timely underwriting • We have a competitive compensation package • Offer world class travel with incentive trips • Purchase quality leads with our affordable lead program
Top in the Industry • Ranked top three provider • Ranked 1st in agent sold Medicare supplement policies • Our earned premium has increased 42.2% in the last four years
MedicareCoverage Medicare Coverage
Medicare Coverage Medicare serves 44.1 million Americans • 36.9 million seniors • 7.2 million disabled persons • Average benefit per enrollee-$10,460 Source: “Medicare Fast Facts” National Committee to Preserve Social Security and Medicare
Medicare - What is it? Medicare is a government regulated health insurance program that provides coverage to: • People age 65 and older • People who are disabled • People who are in permanent kidney failure • People who have ALS (Lou Gehrig’s disease)
Medicare Eligibility-Part A A person is eligible for Part A at age 65* whether working or retired, if that person has been covered by Social Security long enough to qualify for benefits. * Some states allow coverage for individuals under age 65.
Medicare Eligibility-Part A • A person who is under age 65 can get Part A benefits without paying premiums if he or she has received Social Security or Railroad Board disability benefits for 24 months. • People with ALS get Part A the month their disability benefits begin. • Persons, aged 65, who are not eligible under these conditions may enroll in Part A by paying the full cost.
Medicare Enrollment-Part A Part A is premium-free for those who are eligible for Social Security or Railroad Retirement benefits.
Medicare Enrollment-Part B • Everyone who is entitled to Part A is automatically enrolled in Part B, but may reject it. • There is a premium charge for Part B. • Participants are encouraged to purchase Part B because the federal government pays three-fourths of the premium cost.
Initial Enrollment Period An individual may join Medicare: • No sooner than three months prior to the month of his or her 65th birthday. • During the month of his or her 65th birthday. • No later than three months after the month of his or her birthday. • Mutual extends the Medicare supplement enrollment period-adding three months to each period.
Medicare Coverage Medicare is divided into two parts: • Part A—in-patient hospital insurance • Part B—supplemental medical insurance
Medicare – Part A Part A provides in-patient hospital care • Pays for a portion of services in • hospitals, • skilled nursing facilities, • home health care and • hospice care • Doesn’t cover physician or medical services
Covered Hospital Services Part A covered hospital services : • Room and board (semiprivate) • Operating and recovery room costs • Laboratory tests and x-rays • Drugs and medical supplies such as dressings • General nursing and rehabilitation services • Durable Medical Equipment • Blood Transfusions (after first three pints)
Benefit Periods A benefit period: • begins the first day a person receives Medicare covered services in a hospital and • ends when the patient has been out of the hospital or skilled nursing facility for 60 days in a row.
New Benefit Period • If a person enters a hospital again after 60 days, a new benefit period begins. • All Part A benefits (except for the lifetime reserve days) are renewed. • There is no limit to the number of benefit periods a person can have for hospital or skilled nursing facility care.
Reserve Days • Hospital inpatient reserve days are a lifetime reserve of 60 days. • A reserve day can be used only one time. • Reserve days are not renewable for a second benefit period the way the first 90 days are.
Inpatient Hospital Benefits • Inpatient Hospital Coverage - Part A • Participant pays $1,068.00 for first 60 days • The participant’s coinsurance is: • - $267 for days 61-90 • - $534 for days 91-150 (Lifetime Reserve) • -Full cost for days 151st and after (Medicare pays $0 cost)
Skilled Nursing Facility Care • Medicare helps pay up to 100 days of care during a benefit period. • Medicare will pay benefits only if the skilled nursing facility(primarily provides skilled nursing and rehabilitation services)is certified by Medicare.
Skilled Nursing Facility Care Skilled Nursing Care Services: • Semiprivate room and all meals • Regular nursing and rehabilitation services • Medications and medical supplies and appliances
Skilled Nursing Facility Benefits Skilled Nursing Care Benefits • Participant’s Coinsurance is: - $0 for the first 20 days (Medicare pays 100%) - $133.50 a day for days 21-100 - 100% (Medicare pays 0% after day 100)
Home HealthCare Services Covered home health care services when confinement is at home include: • Part-time nursing care • Physical, speech and occupational therapy • Medical social and home health aide services • Use of medical supplies and durable medical equipment There is no longer a requirement for hospitalization nor any maximum on the number of visits.
Home Health Care Benefits To receive Medicare home health care benefits, an individual must meet four conditions: • A physician certifies the individual needs care at home and develops a plan of care. • The individual needs skilled nursing care or therapeutic nursing services. • The individual must be confined to home. • The agency must be Medicare approved.
Home Health Care Benefits Home Health Care benefits: • Participant pays nothing except for durable medical equipment which is subject to a 20% coinsurance under Part B. Services must be provided by a Medicare certified home health agency. A home health agency is defined as a public or private agency that specializes in skilled nursing services and other therapeutic nursing services.
Hospice Benefits-Part A Under certain conditions, Part A can pay for hospice care for terminally ill persons. Covered services include: • Physician services/Nursing care • Medical appliances and supplies • Outpatient drugs for pain relief • Short-term in-patient care • Counseling/therapies • Home health aide and homemaker services
Hospice Benefits Hospice benefits are paid as follows: • Medicare pays 100% for covered services. • Participant pays: limited cost for outpatient drugs and inpatient respite care.
Blood • Blood is covered under Medicare Part A and Part B. • When blood is required, participant pays for first three pints.
Medicare – Part B Part Bcan help pay for: • Physician and surgeon services • Home health visits for patients requiring skilled care • Physical therapy and speech pathology services on an outpatient basis and on a limited basis in the patient’s home. • Miscellaneous medical services and supplies
Medicare Part B Benefits • The Participant pays: • The Part B calendar year deductible -$135 • 20% of the Coinsurance
Medicare Approved Charges • Medicare bases it payments on “reasonable charges.” • Medicare can pay only 80% of the approved charge, even if it is less than the actual charge. • For entities not taking “assignment” the Medicare beneficiary would pay any excess charges.
Exclusions Medicare provides basic protection, it does not cover all of a person’s health care expenses. It does not pay for: • Services not reasonable, necessary or outside the U. S. • Personal comfort items and most immunizations • Cosmetic surgery, drugs or medicines taken at home (except for hospice) • Eye exams/Dental /Foot care/Hearing aids/Acupuncture • Private nurses • Custodial care/intermediate care/skilled care beyond 100 days a year.
Medicare Supplements Medicare Supplement Insurance Plans
Medicare Supplement Insurance Basic Things You Should Know: • Duplicate coverage is not allowed. • You are required to provide an outline of coverage and “Guide to Health Insurance for People with Medicare” to each Medicare client at the time of sale. • Policy must be delivered within 30 days from date of issue.
Medicare Supplement Insurance • Private insurance subject to federal and state laws designed to help pay where Medicare does not pay • Standardized Plans A - J • Plan A is basic; Plan J has the most coverage • Plans B - J contain at least Plan A benefits • Two new plans- K and L
Medicare Supplement-Basic Benefits Plans A-J must have five basic benefits: • Part A hospital co-insurance for 61-90 days in a benefit period. • Part A hospital co-insurance for lifetime reserve days 91-150. • Must pay eligible expenses for an additional 365 hospital days after Medicare benefits end. • Must pay 20% of Medicare approved expenses after the calendar year deductible is met. • Must all pay for the first three pints of blood (annually).
Medicare Plans K and L Plans K and L: • Offer most of the same benefits as A-G • Have lower monthly premiums • Cost-sharing has set limits • Have higher co-payments • Provide no coverage for the Part B deductible • Have caps on out-of-pocket costs
Medicare Plan K • Covers 100% of the Part A hospital coinsurance, additional 365 days and Part B cost sharing for preventive services • Covers 50% of the Part A deductible, Skilled Nursing coinsurance for days 21-100, Part A coinsurance for hospice care, Part B co-insurance and the first three pints of blood until the annual out-of-pocket is met • Out-of-pocket limit increases each year for inflation
Medicare Plan L • Covers 100% of the Part A hospital coinsurance, additional 365 days and Part B cost sharing for preventive services. • Covers 75% of the Part A deductible, Skilled Nursing coinsurance for days 21-100, Part A coinsurance for hospice care, Part B co-insurance and the first three pints of blood until the annual out-of-pocket is met. • Out-of-pocket limit increases each year for inflation.
Medicare Supplement Plans Medicare Supplement Plans
Medicare Supplement Plans Medicare Plans A – G • Part A deductible • Part A coinsurance • Lifetime reserve days • Additional 365 days • Skilled nursing facility care • Blood (first three pints)
Medicare Supplement Plans Medicare Plans A – G • Part B deductible • Part B coinsurance • Emergency care outside the U.S. • Part B excess charges • At-home recovery • Basic drugs
Mutual Care SELECT • Mutual Care SELECT contains a group of participating network hospitals. • Part A deductible is waived when services are received from participating network hospitals. • If services are received out of network, Part A deductible is not waived. • We will cover the cost of Part A deductible when Insured receives emergency services from a nonparticipating hospital.
Mutual Care SELECT Plans B – G • Part A deductible • Part A coinsurance • Lifetime reserve days • Additional 365 lifetime reserve days
Mutual Care SELECT Plans B – G • Skilled nursing facility care • Part B deductible • Part B coinsurance • Blood(first three pints)
Mutual Care SELECT Plans B – G • At-home recovery • Part B excess charges • Emergency care outside the U.S. • Preventive care